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High dose steroids increase bacterial infection rates in children with juvenile arthritis

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Children with juvenile idiopathic arthritis have higher rates of bacterial infection requiring hospitalization and use of high-dose steroids significantly increases that risk, according to a study published in Arthritis & Rheumatism.

Researchers found the risk of infection in patients with juvenile idiopathic arthritis (JIA) increased through steroid use, according to a University of Alabama at Birmingham press release. Other commonly used medications, such as methotrexate and tumor necrosis factor (TNF) inhibitors, did not increase the risk, based on the study results.

“Among children with JIA, questions have persisted about a possible increased risk of serious infections associated with the use of TNF inhibitors,” study author Timothy Beukelman, MD, MSCE, stated in the release. “But the relationship between JIA and serious bacterial infections has not been extensively studied and is not well understood.”

According to the study abstract and release, Beukelman and colleagues used national Medicaid data from 2000 through 2005 to identify a cohort of 8,479 children with JIA and 360,489 children with attention deficit hyperactivity disorder (ADHD) as a reference group for the calculation of standardized incidence ratios. They used pharmacy claims to determine medication use and hospital discharge diagnoses to determine infection data.

The researchers found children with JIA demonstrated an increased infection rate — regardless of treatment strategy — compared to the cohort with ADHD, according to the release.

“This finding suggests the inflammatory or autoimmune process itself may predispose children to infection regardless of therapy,” Beukelman stated in the release.

The investigators also found that infection rates were not higher among patients with JIA treated with either methotrexate or TNF inhibitors, but were significantly higher in patients given high-dose glucocorticoids.

“The use of a high dose of glucocorticoid — more than 10 mg of prednisone daily — was consistently associated with a doubling of the infection rate,” Beukelman stated in the release. “This strongly indicates that a treatment strategy that limits steroid use may reduce the risk of serious infection in children with JIA.”

Reference:

• Beukelman T, Haynes K, Curtis JR, et al. Rates of malignancy associated with juvenile idiopathic arthritis and its treatment. Arthritis Rheum. 2012. doi: 10.1002/art.34348.